ProjectSummary TheAmericanSocietyofClinicalOncology(ASCO)recommends??combinedstandardoncologycareand palliativecare?earlyinthecourseofillnessforanypatientwithmetastaticcancerand/orhighsymptom burden?.Unfortunately,earlypalliativecareisnotroutinelyincorporatedintotreatmentplansattheonsetof advanceddiagnosis,therebydeprivingpatientsofpotentialqualityoflifebenefits,especiallylowaccess populationsincludingminoritiesandrural-dwellers.Theproblemisthatwedonotknowhowtobestassist healthsystemswantingtointegrateearlypalliativecareservicesintotheirusualoncologycare.Virtual LearningCollaboratives(VLCs),comprisedofmultiplehealthsystemsthatworktogethervirtuallytoimplement anevidence-basedpractice,offerasolution.VLCfeaturesincludetheformationofqualityimprovementteams, groupproblemsolving,anddatareporting/feedback.DespitewidespreaduseofVLCsinhealthcare,few studieshaveevaluatedtheireffectiveness.Toaddressthisgap,weproposetotesttheeffectivenessofaVLC implementationstrategyonintegrationofanevidenced-basedmodelofearlyconcurrentoncologypalliative carecalledENABLE(Educate,Nurture,Advise,BeforeLifeEnds).ENABLEistheonlyevidence-based, scalableearlypalliativecaremodelpromotedbytheNationalCancerInstitute(NCI)ResearchTested InterventionProgram.GuidedbytheRE-AIMframeworkandusingProctor?sOutcomesforImplementation Researchmodel,weproposeacluster-randomizedtrialwith48NCICommunityOncologyResearchProgram (NCORP)practicesimplementingENABLEtoevaluatetheeffectivenessofaVirtualLearningCollaborative (VLC)comparedtotypicalimplementationconsistingoflimitedtechnicalassistance(TA).InthishybridtypeIII designimplementationeffectivenesstrial,wewillcomparetwoimplementationstrategiesinrealworld oncologypracticestodetermineImplementation(ENABLEuptake),Service,andPatientoutcomes.Studyaims are:1)ComparetheeffectivenessofVLCvs.TAonENABLEprogramuptake,measuredastheproportionof patientsatparticipatingNCORPpracticeswhocompletetheENABLEprogram;?2)Comparetheeffectiveness ofVLCvs.TAonNCORPpracticesimplementationteams?fidelitytoENABLEandassignedimplementation strategy;?3)CompareNCORPpracticesrandomizedtoVLCorTAonpatientandcaregiverqualityoflife(QOL) andmoodoutcomes;?and4)DeterminetherelationshipbetweenENABLEprogramuptakeandfidelityand patients?QOLandmoodacrossthetwostrategies.Thisresearchwillimpactpublichealthbyaddressinga knowledgegaponappropriatestrategiestoimplementscalableevidence-basedpalliativecarepracticeswhile reducingthedisparityofsub-optimalcancercareforadvancedcancerpatients.